Key result
Medicaid insurance shows no difference in ACHF mortality vs private insurance despite lower LVAD use.
Why the study?
Annual heart failure hospitalizations and direct medical costs in the United States are rising significantly, prompting an evaluation of how insurance type affects in-hospital mortality and other outcomes among patients diagnosed with acute-on-chronic heart failure.
Does Medicaid insurance compared to private health insurance affect in-hospital mortality, length of stay, total hospitalization charges, and LVAD utilization in adult patients hospitalized with acute-on-chronic heart failure?
Observational (n=65,900)
Yes
Does Medicaid insurance compared to private health insurance affect in-hospital mortality, length of stay, total hospitalization charges, and LVAD utilization in adult patients hospitalized with acute-on-chronic heart failure?
Answers are grounded in this paper and cite their sources.
In a nationwide US cohort of patients hospitalized for acute-on-chronic heart failure, Medicaid coverage was associated with lower LVAD utilization, shorter hospital stays, and lower hospitalization charges compared to private insurance, without a significant difference in adjusted in-hospital mortality.
Background An estimated more than 6 million adults in the United States live with heart failure (HF), which is projected to affect another 2 million by 2030. Additionally, studies suggest the number of annual hospitalizations for HF have significantly increased over recent years alongside growing direct medical costs for HF treatment, projected to reach more than $50 billion within the next 5 years. Purpose We sought to compare in-hospital mortality and other outcomes among patients diagnosed with acute-on-chronic heart failure (ACHF) in the 2022 NIS, stratified by insurance type. Methods Heart failure patients in the 2022 NIS were categorized based on acuity. ACHF patients were selected using appropriate ICD-10 codes. Primary outcome was in-hospital mortality and secondary outcomes included: length of stay (LOS), total hospitalization charges (TOTCHG) and need for left ventricular assist device (LVAD). Multivariate linear and logistic regression were performed using STATA 19.5. Results Among 65,900 adult patients with diagnosed ACHF, primary insurance status included Medicare (60%), Medicaid (20%), private insurance (16%), and no insurance (4%). ACHF patients with Medicaid had lower odds of mortality versus those with private insurance (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI]: 0.43−0.84 p < 0.001), although statistically insignificant after adjusting for confounders (aOR: 0.76, 95% CI: 0.52−1.11; p = 0.16). Additionally, ACHF patients with Medicaid had significantly lower odds of LVAD utilization (aOR: 0.42, 95% CI: 0.22−0.79; p < 0.001), significantly lower mean TOTCHG (-$36,001, 95% CI: -$69,061 to -$2,941; p = 0.03) and marginally decreased mean LOS versus the privately insured (-0.89 days, 95% CI: -1.68 to -0.11; p = 0.02) irrespective of hospital and patient level characteristics. Conclusion ACHF patients with primary Medicaid insurance had significantly lower TOTCHG and LOS as well as lower odds of undergoing LVAD placement compared to patients with private insurance. There were no statistically significant differences in mortality between the two groups.
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Rojas et al. (2026) conducted an observational in Acute-on-chronic heart failure (ACHF) (n=65,900). Medicaid insurance vs. Private health insurance was evaluated on In-hospital mortality (aOR 0.76, 95% CI 0.52-1.11, p=0.16). Medicaid insurance was not associated with different in-hospital mortality vs private insurance in ACHF (aOR 0.76, 95% CI 0.52-1.11; p=0.16), but had lower LVAD use (aOR 0.42; p<0.001).
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